Pyelonephritis other diagnostic studies: Difference between revisions
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*The infected kidney is usually enlarged, and there is often stranding in the [[perinephric fat]]. | *The infected kidney is usually enlarged, and there is often stranding in the [[perinephric fat]]. | ||
*Delayed views of the infected kidney may demonstrate a nephrogram with increased attenuation. | *Delayed views of the infected kidney may demonstrate a nephrogram with increased attenuation. | ||
===Intravenous Pyelography=== | |||
Intravenous Pyelography (IVP) is done to diagnose an intra-renal or peri-nephric abscesses. IVP is a very sensitive radiological test for this purpose It can also be used to assess the normal functioning of the urinary passage.<ref name="pmid6992728">{{cite journal| author=Hoverman IV, Gentry LO, Jones DW, Guerriero WG| title=Intrarenal abscess. Report of 14 cases. | journal=Arch Intern Med | year= 1980 | volume= 140 | issue= 7 | pages= 914-6 | pmid=6992728 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6992728 }} </ref> | Intravenous Pyelography (IVP) is done to diagnose an intra-renal or peri-nephric abscesses. IVP is a very sensitive radiological test for this purpose It can also be used to assess the normal functioning of the urinary passage.<ref name="pmid6992728">{{cite journal| author=Hoverman IV, Gentry LO, Jones DW, Guerriero WG| title=Intrarenal abscess. Report of 14 cases. | journal=Arch Intern Med | year= 1980 | volume= 140 | issue= 7 | pages= 914-6 | pmid=6992728 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6992728 }} </ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Other Diagnostic Studies
Contrast Nephrograms
Acute Pyelonephritis
- Acute pyelonephritis consists of focal areas of striated or wedge-shaped hypoperfusion, resulting in a characteristic striated nephrogram.
- Striations result from stasis of contrast material within edematous tubules that demonstrates increasing attenuation over time.
- The infected kidney is usually enlarged, and there is often stranding in the perinephric fat.
- Delayed views of the infected kidney may demonstrate a nephrogram with increased attenuation.
Intravenous Pyelography
Intravenous Pyelography (IVP) is done to diagnose an intra-renal or peri-nephric abscesses. IVP is a very sensitive radiological test for this purpose It can also be used to assess the normal functioning of the urinary passage.[1]
Voiding cystourethrogram (VCUG)
A VCUG is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The procedure is performed in an outpatient center or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some people. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the person urinates. This test can show abnormalities of the inside of the urethra and bladder and is usually used to detect VUR in children.[2]
Dimercaptosuccinic acid (DMSA) scintigraphy
DMSA scintigraphy is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive material. Because the dose of radioactive material is small, the risk of causing damage to cells is low. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Radioactive material is injected into a vein in the person’s arm and travels through the body to the kidneys. Special cameras and computers are used to create images of the radioactive material as it passes through the kidneys. The radioactive material makes the parts of the kidney that are infected or scarred stand out on the image. DMSA scintigraphy is used to show the severity of kidney infection or kidney damage, such as scarring. Cortical Scintigraphy is preferred for the diagnosis of acute pyelonephritis in children.[3][4][5]
Histopathological Exam
Xanthoranulomatous Pyelonephritis is usually confused with a malignancy and surgery is performed. The histopathological examination of the resected specimen confirms xanthogranulomatous pyelonephritis which is not a very common phenomenon. Microscopic examination after performing biopsy shows the inflammatory mass composed of lipid-laden macrophages and chronic inflammatory cells.[6]
Urography
Urography can be used to diagnose patients with acute pyelonephritis and in some cases with xanthogranulomatous pyelonephritis[7]
- Classic urographic triad in diffuse xanthogranulomatous pyelonephritis consists of unilaterally decreased or (more commonly) absent renal excretion, a staghorn calculus, and a poorly defined mass or diffuse renal enlargement.
- Failure to respond to antibiotic therapy or recurrence of symptoms may be taken as an indication to perform urography
References
- ↑ Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.
- ↑ Yousefichaijan P, Dorreh F, Shahsavari S, Pakniyat A (2016). "Comparing between results and complications of doing voiding cystourethrogram in the first week following urinary tract infection and in 2-6 weeks after urinary tract infection in children referring to a teaching hospital". J Renal Inj Prev. 5 (3): 144–7. doi:10.15171/jrip.2016.30. PMC 5040001. PMID 27689111.
- ↑ Salihoglu YS, Elri T, Gulle K, Can M, Aras M, Ozacmak HS; et al. (2016). "Evaluation of the protective effect of agmatine against cisplatin nephrotoxicity with 99mTc-DMSA renal scintigraphy and cystatin-C". Ren Fail. 38 (9): 1496–1502. doi:10.1080/0886022X.2016.1227919. PMID 27604130.
- ↑ Benador D, Benador N, Slosman DO, Nusslé D, Mermillod B, Girardin E (1994). "Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis". J Pediatr. 124 (1): 17–20. PMID 8283371.
- ↑ Kawashima A, LeRoy AJ (2003). "Radiologic evaluation of patients with renal infections". Infect Dis Clin North Am. 17 (2): 433–56. PMID 12848478.
- ↑ Yeow Y, Chong YL (2016). "Xanthogranulomatous pyelonephritis presenting as Proteus preperitoneal abscess". J Surg Case Rep. 2016 (12). doi:10.1093/jscr/rjw211. PMC 5159021. PMID 27915241.
- ↑ Sandberg T, Stokland E, Brolin I, Lidin-Janson G, Svanborg Edén C (1989). "Selective use of excretory urography in women with acute pyelonephritis". J Urol. 141 (6): 1290–4. PMID 2724423.